| NPI | 1184719304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: MD D67041) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 220044) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2016-01-08 |