| NPI | 1780607457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AL 20628) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: AL 20628) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2007-07-08 |