| NPI | 1386061596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME155181) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN# 19232) |
| 208600000X Surgery (Licence: NC 2019-02260) | |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2022-06-20 |