| NPI | 1245236447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MA 35010) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: RI MD05149) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2011-02-10 |