| NPI | 1558521567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: DE C1-0011347) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT193766) |
| 2086S0129X Surgery, Vascular Surgery (Licence: NJ 25MA09298000) | |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2015-08-04 |