| NPI | 1740201508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: NY 1247381) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 1247381) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2011-08-30 |