| NPI | 1720091499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NC 200100085) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 200100085) |
| 208600000X Surgery (Licence: OH 35-069667) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: OH 35-069667) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2016-12-05 |