| NPI | 1659359560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD037054-L) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: PA MD037054L) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2026-07-20 |