| NPI | 1619950532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NY 203061) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NY 203061-0) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2012-12-11 |