| NPI | 1083879340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD 60299610) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: OH 35.089252) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2015-12-16 |