| NPI | 1376560714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MO R8P52) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO R8P52) |
| 2083S0010X Preventive Medicine, Sports Medicine (Licence: MO R8P52) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2019-01-24 |