| NPI | 1780623892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X Phlebology (Licence: FL ME45469) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL me45469) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2023-04-24 |