| NPI | 1164466074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MN 34900) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 34900) |
| 2086S0129X Surgery, Vascular Surgery (Licence: IA MD-44408) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2020-11-10 |