| NPI | 1124208459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX n7138) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A94282) |
| Enumeration Date | 2007-11-03 |
| Last Update Date | 2014-08-05 |