| NPI | 1679501704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: LA MD.013676) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME96909) |
| 2086S0129X Surgery, Vascular Surgery (Licence: FL ME96909) | |
| 208C00000X Colon & Rectal Surgery (Licence: FL ME96909) | |
| 208D00000X General Practice (Licence: FL ME96909) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2022-02-11 |