| NPI | 1104185644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CA A130427) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD60748391) |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2021-09-02 |