| NPI | 1972700458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CA A159097) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A159097) |
| 208600000X Surgery (Licence: WA MD 60085533) | |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2022-04-28 |