| NPI | 1457762502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2021-03336) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT206257) |
| 207W00000X Ophthalmology (Licence: MN 65375) | |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2021-12-11 |