| NPI | 1417935974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X Phlebology (Licence: MO 108025) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 108025) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2021-11-05 |