| NPI | 1811958465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WA 00023027) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA 00023927) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2019-05-31 |