| NPI | 1376599142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME152850) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NY 142206) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2022-09-08 |