| NPI | 1760470041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 221205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 221205) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2020-09-02 |