| NPI | 1144653437 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207WX0109X Ophthalmology, Neuro-ophthalmology (Licence: AZ 53907) | 
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 53907) | 
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 75927) | |
| Enumeration Date | 2013-08-09 | 
| Last Update Date | 2017-10-12 |