| NPI | 1558742783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 65042) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10054312) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2019-08-06 |