| NPI | 1669807012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MD D83720) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.022764) |
| Enumeration Date | 2013-09-04 |
| Last Update Date | 2021-06-14 |