| NPI | 1750125209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 16728) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 16728) |
| Enumeration Date | 2024-06-20 |
| Last Update Date | 2024-06-20 |