| NPI | 1962472993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WA MD60019977) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60019977) |
| 208600000X Surgery (Licence: MA 220659) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: NY 226002) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2024-03-08 |