| NPI | 1962436022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX L8610) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: TX L8610) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2025-12-09 |