| NPI | 1760882401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: CA A169661) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA10302700) |
| 208600000X Surgery (Licence: PA MD463921) | |
| 208600000X Surgery (Licence: NY 287637) | |
| Enumeration Date | 2014-08-31 |
| Last Update Date | 2020-09-01 |