| NPI | 1972761799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NJ 25MA08589100) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 25MA08589100) |
| 208600000X Surgery (Licence: NY 245891) | |
| 208600000X Surgery (Licence: PA MD424921) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2024-04-10 |