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 |