| NPI | 1275976839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL Me145402) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2018-01273) |
| 208600000X Surgery (Licence: FL ME145402) | |
| Enumeration Date | 2013-04-14 |
| Last Update Date | 2021-03-03 |