| NPI | 1194027037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX P9206) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301094774) |
| Enumeration Date | 2010-11-29 |
| Last Update Date | 2016-06-13 |