| NPI | 1083601645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 37461) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: WI 37461) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2019-04-24 |