| NPI | 1053301770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MA 216882) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NY 211461) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2014-01-31 |