| NPI | 1003027822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 20033) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: SC 20033) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2018-05-15 |