| NPI | 1528898038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MN 78317) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NY 333269) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2024-11-06 |