| NPI | 1134569817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 7016) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NE 7016) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2013-06-26 |