| NPI | 1467558072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 40978) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: CO 40978) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2013-03-11 |