| NPI | 1538122361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: FL ME0046885) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME0046885) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2009-02-13 |