| NPI | 1629291919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: MS 19374) |
| Additional Taxonomies | 208600000X Surgery (Licence: MS 19374) |
| 208C00000X Colon & Rectal Surgery (Licence: MS 19374) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2008-05-27 |