| NPI | 1780834770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CA 136744) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 237961) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2015-08-26 |