| NPI | 1215058011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: UT 5210452-1205) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD00047866) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2012-04-27 |