| NPI | 1205899481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301044283) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: AR T2007-006) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2012-06-19 |