| NPI | 1154850956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A164403) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 272551) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2022-06-29 |