| NPI | 1003164112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD61096401) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD61096401) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2022-09-13 |