| NPI | 1831359983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MN 65103) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MO 2017018908) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2021-03-11 |