| NPI | 1134151772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X Phlebology (Licence: PA MD020555E) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: PA MD020555E) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2008-05-22 |