| NPI | 1447398805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 053529) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MA 053529) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2015-07-28 |