| NPI | 1780652727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME 118298) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MD DOO17095) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2016-10-14 |