| NPI | 1134148810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 161970) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: NY 161970) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2012-07-12 |