| NPI | 1134300387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX P2477) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX P2477) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2018-01-15 |