| NPI | 1134174436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: NC 2009-00158) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2009-00158) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2019-07-30 |