| NPI | 1043249683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X Phlebology (Licence: PA MD028210E) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD028210E) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2008-11-21 |