| NPI | 1407084247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: VA 0101258238) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC 00000000000000000) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2017-08-18 |