| NPI | 1568525764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MI 5101006766) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: MI AF006766) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2011-08-23 |