| NPI | 1033191994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: MI 4301069776) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: OH 35-084264) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2021-03-01 |