| NPI | 1851403109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA G58383) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: CA G58383) |
| 2086S0129X Surgery Vascular Surgery (Licence: CA G58383) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-09 |