| NPI | 1770624116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PR 6725) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: AZ 19939) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2007-07-08 |