| NPI | 1861451346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 0416656) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: KS 0416656) |
| 207R00000X Internal Medicine (Licence: MO 117885) | |
| 207R00000X Internal Medicine (Licence: TX Q2669) | |
| 202K00000X Phlebology (Licence: TN MD0000054563) | |
| 202K00000X Phlebology (Licence: CT 56083) | |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2017-03-28 |