| NPI | 1538588272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: OR MD194705) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD60965892) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2019-10-29 |