| NPI | 1386667780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: CA A36734) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA 00A367340) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2016-02-25 |