| NPI | 1376535807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: KY 18650) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 18650) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2010-06-30 |