| NPI | 1740234335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: KY 42475) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101033088) |
| 2086S0129X Surgery Vascular Surgery (Licence: VA 0101033088) | |
| 208C00000X Colon & Rectal Surgery (Licence: VA 0101033088) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2012-04-12 |