| NPI | 1720102288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VT BF4323200SW) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: MD D0071822) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2011-08-24 |