| NPI | 1477552982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NM 2001121) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: PA MD043777L) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2010-08-05 |