| NPI | 1558920249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 95537) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04702) |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2023-09-27 |