| NPI | 1619102662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NJ 25MA09224300) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: ME MD18187) |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2013-01-30 |