| NPI | 1275672347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X Phlebology (Licence: TX M6646) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO 45278) |
| 208600000X Surgery (Licence: TX M6646) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2016-05-04 |