| NPI | 1972847671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME136710) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301093311) |
| 2086S0129X Surgery, Vascular Surgery (Licence: WV 26404) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: MN 63402) | |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2019-12-20 |