| NPI | 1205822442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208600000X Surgery (Licence: WY 3032A) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: WY 3032A) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2007-07-09 |