| NPI | 1104835479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MD D44679) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D44679) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2008-04-29 |