| NPI | 1558700658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD182486) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 256653) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2021-12-01 |