| NPI | 1902836216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MO 2004029630) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: AR E4582) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2010-11-01 |