| NPI | 1649271446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: FL ME0030499) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: FL ME0030499) |
| 208600000X Surgery (Licence: FL ME30499) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2018-07-25 |