| NPI | 1497909931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CA A112342) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301091346) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2020-02-06 |