| NPI | 1740268325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD00045479) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD00045479) |
| 208600000X Surgery (Licence: WA MD00045479) | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2021-06-23 |