| NPI | 1174783450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: GA 62820) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036-110325) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2011-07-06 |