| NPI | 1902995665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX L8508) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NJ 25MA54803) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-04-29 |