| NPI | 1790780823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: LA 11716) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 11716) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2009-01-14 |