| NPI | 1124008032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CO 31124) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MN 32023) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2019-08-01 |