| NPI | 1023394665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NE 26509) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.095909) |
| 2086S0129X Surgery, Vascular Surgery (Licence: OH 35.095909) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: IA 40563) | |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2015-02-20 |