| NPI | 1073541876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CA G51713) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA G51713) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2024-02-29 |