| NPI | 1053555110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X Phlebology (Licence: AZ 873) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: AZ 006421) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2025-09-02 |