| NPI | 1265505622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: GA 62255) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 62255) |
| 208600000X Surgery (Licence: FL ME 97064) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2011-10-13 |