| NPI | 1750622726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MN 65742) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 280161) |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2023-07-07 |