| NPI | 1871525477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: CA G68376) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G68376) |
| 2086S0127X Surgery Trauma Surgery (Licence: CA G68376) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2012-04-27 |