| NPI | 1497740484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME113727) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA05126100) |
| 2086S0129X Surgery, Vascular Surgery (Licence: NJ 25MA05126100) | |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2016-09-21 |