| NPI | 1578833737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: AZ 1476) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: MO 10570) |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2012-01-05 |