| NPI | 1669600698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CT 049872) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA mt195605) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2014-10-08 |