| NPI | 1629145974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CO 44862) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO 44862) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2015-11-04 |