| NPI | 1104803352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WI 63607) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: IN 01030418A) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2017-04-12 |