| NPI | 1164615738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: SD 9157) |
| Additional Taxonomies | 174400000X Specialist (Licence: NE 5236) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2014-06-30 |