| NPI | 1164420816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: PA MD028193E) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 138069-1) |
| 208600000X Surgery (Licence: FL ME 121565) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2015-04-09 |