| NPI | 1578548459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: NY 154245) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: CT 043639) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2016-02-11 |