| NPI | 1902121635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD60834494) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60834494) |
| 2086S0129X Surgery, Vascular Surgery (Licence: WI 65321) | |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2021-04-15 |