| NPI | 1245223874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301043561) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: MI 4301043561) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2007-07-08 |