| NPI | 1205253408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO DR.0059786) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MT207872) |
| 207R00000X Internal Medicine (Licence: AZ R74549) | |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2019-04-04 |