| NPI | 1215175112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ MA22311) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: NJ MA22311) |
| Enumeration Date | 2009-01-30 |
| Last Update Date | 2009-01-30 |