| NPI | 1619906328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD00018502) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00018502) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2015-03-03 |