| NPI | 1972590107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 37740) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: CO 37740) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2026-03-31 |