| NPI | 1891797429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX L1987) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX L1987) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2014-01-08 |