| NPI | 1407124357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX P0976) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: CT 56994) |
| Enumeration Date | 2011-12-07 |
| Last Update Date | 2018-07-27 |