| NPI | 1316935778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00028093) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL me77559) |
| 2086S0129X Surgery, Vascular Surgery (Licence: CA G71589) | |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2021-05-18 |