| NPI | 1609189893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A129409) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD P25846) |
| 207W00000X Ophthalmology (Licence: PA MD447468) | |
| 207W00000X Ophthalmology (Licence: MI 4301106769) | |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2016-06-29 |