| NPI | 1801916630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: AZ 005223) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 005223) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2014-09-04 |