| NPI | 1518161215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301078566) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: MI 4301078566) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2023-04-07 |