| NPI | 1366769911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101259808) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT196874) |
| Enumeration Date | 2010-04-22 |
| Last Update Date | 2016-09-27 |