| NPI | 1013210459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NC 201801995) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34.011377) |
| Enumeration Date | 2010-12-07 |
| Last Update Date | 2018-12-06 |