| NPI | 1104933985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 00A357430) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: CA 00A357430) |
| 2086S0129X Surgery Vascular Surgery (Licence: CA 00A357430) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2008-09-30 |