| NPI | 1184876179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX N0756) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: TX N0756) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2018-03-27 |