| NPI | 1902883002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60057929) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: IN 01048762A) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2021-10-08 |