| NPI | 1144412529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD177180) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML20009072) |
| 2086S0129X Surgery, Vascular Surgery (Licence: OR MD177180) | |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2016-09-02 |