| NPI | 1154153070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X Phlebology (Licence: FL EXEMPT) |
| Additional Taxonomies | 246Q00000X Spec/Tech, Pathology |
| 246Z00000X Specialist/Technologist, Other | |
| 247200000X Technician, Other | |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2025-07-25 |