| NPI | 1215911813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: NE 18497) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: IA 31435) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2014-08-06 |