| NPI | 1083108070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 12644826-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.072098) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2022-06-15 |