| NPI | 1265541874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: KY 40138) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 40138) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2018-06-27 |