| NPI | 1184911752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: NJ 25MA10451600) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT196194) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2022-01-05 |