| NPI | 1023065430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 137911) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: NY 137911) |
| 2086S0129X Surgery Vascular Surgery (Licence: NY 137911) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2008-03-06 |