| NPI | 1518529650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301509010) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04749) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2023-07-11 |