| NPI | 1114125069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME122930) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2007019204) |
| 2086S0129X Surgery, Vascular Surgery (Licence: TX P7441) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2015-05-27 |