| NPI | 1154380301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A30429) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: CA A30429) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2018-04-27 |