| NPI | 1487212312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 1015707) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT218228) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2023-11-14 |