| NPI | 1104859081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD00041963) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00041963) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2015-03-03 |