| NPI | 1942430491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MN 60473) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 60473) |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2021-03-11 |