| NPI | 1477549954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 168229) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: NY 168229) |
| 2086S0129X Surgery Vascular Surgery (Licence: NY 168229) | |
| 208600000X Surgery (Licence: FL ME62669) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2008-12-29 |