| NPI | 1730150509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME0058182) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME0058182) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2013-06-14 |