| NPI | 1073600979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: OH 34.005124) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND 7886) |
| 2086S0129X Surgery, Vascular Surgery (Licence: ND 7886) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2018-01-11 |