| NPI | 1306043211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: AZ 40387) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: MN 49960) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2014-09-12 |