| NPI | 1770928780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MN 59457) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 59457) |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2018-07-03 |