| NPI | 1649539339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL 155660) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 284878) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2022-04-26 |