| NPI | 1093758484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD09424) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00043729) |
| 2086S0129X Surgery, Vascular Surgery (Licence: OR MD09424) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: WA MD00043729) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2012-04-13 |