| NPI | 1558781856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 201902519) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 201105) |
| 207W00000X Ophthalmology (Licence: UT 10658076-1205) | |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2022-09-07 |