| NPI | 1093746331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: FL ME21215) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME21215) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2016-07-20 |