| NPI | 1770760522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: TX N8021) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: CA 20A9963) |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2014-03-28 |