| NPI | 1316956444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X Phlebology (Licence: TX G9695) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX G9695) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2016-03-31 |