| NPI | 1861771826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NY 299422) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 299422) |
| 208600000X Surgery (Licence: PA MT199811) | |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2022-01-19 |