| NPI | 1669520912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: OH 35-093280) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN5785) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2012-05-21 |