| NPI | 1003887217 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AR 201408921) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: AR 201408921) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2010-12-08 |