| NPI | 1023206943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: NY 252961) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 252961) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2013-11-21 |