| NPI | 1073512976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 5566) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 49240) |
| 2086S0129X Surgery, Vascular Surgery (Licence: WI 49240) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: AZ 5566) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2016-07-26 |