| NPI | 1447258801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: WA MD00022578) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00025578) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2022-01-17 |