| NPI | 1336700863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2020013957) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2019021888) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2026-07-07 |