| NPI | 1972508968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: AZ 3721) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 3721) |
| 208600000X Surgery (Licence: AL DO-900) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2021-05-10 |