| NPI | 1649271925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MD H0062393) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 239940) |
| 208600000X Surgery (Licence: FL OS14009) | |
| 208600000X Surgery (Licence: NJ 25MB06746000) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2024-11-03 |