| NPI | 1255511788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X Phlebology (Licence: CA G062714) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA G062714) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2007-11-13 |