| NPI | 1578729604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 52313) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: CT 52313) |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2023-08-24 |