| NPI | 1023067170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX G0794) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: TX G0794) |
| 2086S0129X Surgery, Vascular Surgery (Licence: AZ 34729) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2012-02-28 |