| NPI | 1366406563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME0042608) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME0042608) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2010-03-31 |