| NPI | 1285958967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD60918935) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: WI 66585-20) |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2019-08-28 |