| NPI | 1659319747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101-056878) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: VA 0101-056878) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2011-08-14 |