| NPI | 1114373941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MO 2023016174) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MN 68939) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2023-12-21 |