| NPI | 1609852755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD 015680E) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: PA MD 015680E) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2008-09-02 |