| NPI | 1205930815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CO DR.0060353) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MO 105778) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2018-08-22 |