| NPI | 1295049286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 5101018892) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: SC 37599) |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2017-02-02 |