| NPI | 1679766943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME142276) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: FL ME142276) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2025-02-15 |