| NPI | 1417018862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 35139) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: MT 115356) |
| 2086S0129X Surgery Vascular Surgery (Licence: MA 29415) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2025-08-05 |