| NPI | 1962776245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CA A147947) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.058017) |
| Enumeration Date | 2012-03-03 |
| Last Update Date | 2020-12-15 |