| NPI | 1225037435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: RI RI7525) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH 20154) |
| 208600000X Surgery (Licence: VA 0101268741) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: RI MD07525) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2022-09-27 |