| NPI | 1205215787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD468248) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT208022) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2019-11-04 |