| NPI | 1710240643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WI 70387) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MN 62386) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2021-12-14 |