| NPI | 1902899057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NY 175936) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 175936) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2016-06-06 |