| NPI | 1801294772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 24054) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: MS 24054) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2021-08-12 |