| NPI | 1003883612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME146721) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: GA 034166) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2021-05-13 |