| NPI | 1194097873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CA C25858) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: CA CA) |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2012-01-27 |