| NPI | 1811949670 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NY 160375) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 160375) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2024-03-27 |