| NPI | 1699235689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MN 68317) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MN 30020) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2020-10-19 |