| NPI | 1659331742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X (Licence: TN MD0000037908) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: TN MD0000037908) |
| 207Q00000X Family Medicine (Licence: TN MD0000037908) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2021-05-05 |