| NPI | 1841211067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WI 61676) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 46852) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2021-03-23 |