| NPI | 1912028853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME106633) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA08134900) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2022-07-13 |