| NPI | 1417310855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 45509) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 45509) |
| 208D00000X General Practice (Licence: AZ 45509) | |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2021-12-28 |