| NPI | 1083669097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: OH 34-008446) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34-008446) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2020-06-10 |