| NPI | 1457765265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: ME MD27672) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MI 4301106096) |
| 2086S0129X Surgery, Vascular Surgery (Licence: FL ME152602) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2024-01-03 |