| NPI | 1699735506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H0084977) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 232022) |
| 2086S0129X Surgery Vascular Surgery (Licence: NY 232022) | |
| 2086S0129X Surgery Vascular Surgery (Licence: FL OS13639) | |
| 208600000X Surgery (Licence: FL OS13639) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2019-03-12 |