| NPI | 1679575443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: GA 056512) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 056512) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2010-02-18 |