| NPI | 1629167176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NY 166525) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 166525) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2010-11-04 |