| NPI | 1083616148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MA 213070) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 213070) |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2020-01-02 |