| NPI | 1255535639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: NY 279135) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: VA 0101054429) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2025-06-16 |