| NPI | 1962846873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: GA 83930) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R73457) |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2020-04-07 |