| NPI | 1538424007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: FL ME137272) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: RI MD14884) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2021-06-23 |