| NPI | 1184640401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: MO R1F49) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MO R1F49) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2010-08-13 |