| NPI | 1417905043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NJ 25MA06910800) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301510207) |
| 2086S0129X Surgery, Vascular Surgery (Licence: PA MD057930L) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2024-06-06 |