| NPI | 1114668225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MN 33471) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MN 77655) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2024-08-15 |