| NPI | 1134106370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: OH 033959) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MI 029614) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2023-03-20 |