| NPI | 1083645402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MO 2011001440) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: KY 42797) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2014-01-27 |