| NPI | 1639282643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MO 36181) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 36181) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2011-01-20 |