| NPI | 1619537776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 346306) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2019018937) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2025-07-10 |