| NPI | 1528114113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: OR MD27104) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD27104) |
| 2086S0129X Surgery, Vascular Surgery (Licence: UT 280001-1205) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2010-06-02 |