| NPI | 1215280490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MO 2021031240) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NJ 25MB09792800) |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2021-08-05 |