| NPI | 1790873859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35-036889) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: OH 35-036889) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2010-09-22 |