| NPI | 1508839028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: VA 0101230775) |
| Additional Taxonomies | 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: VA 0101230775) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2019-01-03 |