| NPI | 1780818278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD07272) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: OR MD07272) |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2009-05-12 |