| NPI | 1578900189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301103153) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301103153) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2019-02-27 |