| NPI | 1639102460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO R4278) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: MO R4278) |
| 2086S0129X Surgery Vascular Surgery (Licence: MO R4278) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2011-02-28 |