| NPI | 1144225319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X Phlebology (Licence: IL 036114542) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35063661) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2018-10-31 |