| NPI | 1639583859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2019-01287) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD P30103) |
| 207W00000X Ophthalmology (Licence: CT 60908) | |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2019-05-22 |