| NPI | 1558866517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME166833) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: FL ME166833) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2026-04-20 |