| NPI | 1972882777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME 42000) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: LA MD.014985) |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2011-08-10 |