| NPI | 1790937175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: OH 35.133029) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA09052800) |
| 2086S0129X Surgery, Vascular Surgery (Licence: NJ 25MA09052800) | |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2018-12-20 |