| NPI | 1104070705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: PR 021391) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NY 265300) |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2019-12-20 |