| NPI | 1760820484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NY 316765) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA L-255744) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2022-07-21 |