| NPI | 1629103619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX H6529) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: OK 16951) |
| 208600000X Surgery (Licence: TX H6529) | |
| 208600000X Surgery (Licence: OK 16951) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2015-10-18 |