| NPI | 1477504363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NY 168069) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 168069) |
| 208600000X Surgery (Licence: NY 168069) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2022-03-22 |