| NPI | 1083605117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MA 203033) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2006-01219) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2007-10-08 |