| NPI | 1609960889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MS 10068) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MS 10068) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: MS 10068) | |
| 207Q00000X Family Medicine (Licence: MS 10068) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2017-07-25 |