| NPI | 1972980761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: SC 87875) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: VA 0101264568) |
| 2086S0129X Surgery, Vascular Surgery (Licence: PA MT205085) | |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2022-11-23 |