| NPI | 1184613341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: TX M8262) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: OH 35074962) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2019-04-22 |