| NPI | 1912101361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX M6927) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX M6927) |
| 2086S0127X Surgery, Trauma Surgery (Licence: TX M6927) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2015-04-15 |