| NPI | 1619181203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO DR0054511) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301087648) |
| 207W00000X Ophthalmology (Licence: MI 4301087648) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2022-01-13 |