| NPI | 1558572164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: GA 05962) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: TN MD0000039910) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2018-06-28 |