| NPI | 1992792907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: IA 23450) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 23450) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2012-07-30 |