| NPI | 1215993209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY TP082) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME93263) |
| 2086S0129X Surgery, Vascular Surgery (Licence: KY TP082) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2014-10-20 |