| NPI | 1629489232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC MD52432) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT206410) |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2020-08-19 |