| NPI | 1568954410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: PA OS025085) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 208600000) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2025-08-19 |