| NPI | 1760417109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: ME 016694) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MN 35601) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2010-07-12 |