| NPI | 1518512680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: KY 58790) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 30232) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2024-06-26 |