| NPI | 1831151497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NM 75-199) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM 75-199) |
| 2086S0129X Surgery Vascular Surgery (Licence: NM 75-199) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2014-12-22 |