| NPI | 1972650778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: VA 0101260275) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 27458) |
| 2086S0129X Surgery, Vascular Surgery (Licence: TN 43806) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2022-03-25 |