| NPI | 1003831447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA G35691) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: CA G35691) |
| 2086S0129X Surgery, Vascular Surgery (Licence: CA G35691) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2013-01-09 |