| NPI | 1376947135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: ID O-1950) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NJ 25MB09673900) |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2024-03-18 |