| NPI | 1972586212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 105496) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NY 105496) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2011-06-27 |