| NPI | 1679595128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO0085) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 0085) |
| 207W00000X Ophthalmology (Licence: FL OS3199) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2022-04-06 |