| NPI | 1679551469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX T3610) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NY 194966-1) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2021-10-20 |