| NPI | 1598965006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: GA 66855) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: OH 35.094050) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2019-06-16 |