| NPI | 1073654919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD435916) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NJ MA028391) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2013-05-30 |