| NPI | 1477634681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 39282) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: MA 39282) |
| 208600000X Surgery (Licence: AZ 47782) | |
| 208600000X Surgery (Licence: OK 31234) | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2016-03-24 |