| NPI | 1508868001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX D4981) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX D4981) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2013-01-24 |