| NPI | 1487617627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CA G48515) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G48515) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2013-04-16 |