| NPI | 1972910834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: KY 55378) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: IN 01086376A) |
| Enumeration Date | 2014-07-12 |
| Last Update Date | 2021-08-13 |