| NPI | 1790070969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD60683789) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: AK 152620) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2022-04-13 |