| NPI | 1508495219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NY 390200000X) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NY 123456789) |
| Enumeration Date | 2020-04-04 |
| Last Update Date | 2020-04-04 |