| NPI | 1811078132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD13941) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: OR MD13941) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2008-09-08 |