| NPI | 1942515408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: CT 60086) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: MN 60214) |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2021-08-03 |