| NPI | 1164413381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: LA 14474R) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: LA 14474R) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2020-02-18 |