| NPI | 1609202274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA G27038) |
| Additional Taxonomies | 207RA0201X Internal Medicine Allergy & Immunology (Licence: CA G27038) |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2013-09-16 |