| NPI | 1962814343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NJ 25MA10839600) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT206580) |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2022-08-22 |