| NPI | 1598964215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD60743971) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID M12416) |
| 2086S0129X Surgery, Vascular Surgery (Licence: ID M12416) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2021-10-20 |