| NPI | 1972626992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: FL ME104229) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: MA 230985) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2011-02-11 |