| NPI | 1063625317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MO R9N91) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MO R9N91) |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: FL ME102374) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2018-02-14 |