| NPI | 1275784670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 261287) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA os013322) |
| 2086S0129X Surgery, Vascular Surgery (Licence: NY 261287) | |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2020-11-25 |