| NPI | 1154390730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME98427) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: LA 023433) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2012-01-09 |