| NPI | 1396182242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2017022831) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN19098) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2022-07-21 |