| NPI | 1982853750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX N2566) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: IL 036.119557) |
| 208600000X Surgery (Licence: IL 036.119557) | |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2021-12-28 |