| NPI | 1336104793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C25377) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: CA C25377) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2010-08-03 |