| NPI | 1760568240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX G0720) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: TX GO720) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2018-10-09 |