| NPI | 1205217346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 278378) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 264198) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2024-08-01 |