| NPI | 1124513023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 12685949-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2018020280) |
| 207W00000X Ophthalmology (Licence: MO 2018020280) | |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2022-06-22 |