| NPI | 1043579600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD60878025) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: TX BP10044151) |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2020-07-23 |