| NPI | 1952843757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: ID MC-2209) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD61141095) |
| 2086S0129X Surgery, Vascular Surgery (Licence: CA 145846) | |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2023-07-28 |