| NPI | 1114041126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME115599) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD60398838) |
| 2086S0129X Surgery, Vascular Surgery (Licence: OH 35.091344) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2013-08-20 |