| NPI | 1952563736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 237270) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: CT 64226) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2021-12-16 |