| NPI | 1891994323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MN 53427) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 117101) |
| Enumeration Date | 2007-07-14 |
| Last Update Date | 2023-08-21 |