| NPI | 1689602229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA09093500) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2006-00595) |
| 2086S0129X Surgery, Vascular Surgery (Licence: NC 2006-00595) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2021-04-26 |