| NPI | 1376624759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: GA 025254) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: MA 151308) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2015-11-02 |