| NPI | 1134295124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 45999) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G71398) |
| 208600000X Surgery (Licence: PA MD048605L) | |
| 2086S0129X Surgery Vascular Surgery (Licence: TN MD0000037623) | |
| 2086S0129X Surgery Vascular Surgery (Licence: PA MD048605L) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2018-03-17 |