| NPI | 1013918226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 105746 1) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NY 105746 1) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2010-06-17 |