| NPI | 1912974023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX P2579) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD 60604669) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2022-03-03 |