| NPI | 1922061423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: MN 54700) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 105765) |
| 2086S0129X Surgery Vascular Surgery (Licence: WI 56339-20) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2022-09-02 |