| NPI | 1891790259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 9800894) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NC 200001830022) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2010-10-29 |