| NPI | 1194711150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: KY 29604) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 29604) |
| 208600000X Surgery (Licence: KY 29604) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2015-10-01 |