| NPI | 1861431090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X Phlebology (Licence: NY 180444) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 180444) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2025-09-11 |