| NPI | 1932165321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD 60118824) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MO 20050400008) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2016-03-09 |