| NPI | 1972866846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME121772) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: VA 0101262404) |
| Enumeration Date | 2012-06-16 |
| Last Update Date | 2024-04-03 |