| NPI | 1053632323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MN 58744) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10036857) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2021-03-11 |