| NPI | 1053385583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: PA MD056226L) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NY 205449-1) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2021-03-09 |