| NPI | 1801979992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: OH 35.091388) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: NY 153684) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2012-08-01 |