| NPI | 1922077387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO 32309) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: CO 32309) |
| 2086S0102X Surgery Surgical Critical Care (Licence: CO 32309) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2016-03-12 |