| NPI | 1104872688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: RI MD04946) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 31719) |
| 2086S0129X Surgery, Vascular Surgery (Licence: RI MD4946) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2007-09-26 |