| NPI | 1306819974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WY TL#1137) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: WI 27613020) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2009-06-16 |