| NPI | 1891051314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD60957094) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60957094) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2019-09-09 |