| NPI | 1831114974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD27109) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00042389) |
| 208600000X Surgery (Licence: CO DR.0061555) | |
| 2086S0129X Surgery Vascular Surgery (Licence: TX M3023) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2018-11-27 |