| NPI | 1346395985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 33850) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: CO 33850) |
| 202K00000X (Licence: CO 33850) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2013-02-22 |