| NPI | 1386638005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: UT 11889299-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 249582) |
| 2086S0129X Surgery, Vascular Surgery (Licence: PA MD469103) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: SC 83219) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2024-03-14 |