| NPI | 1770014219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A172206) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 271608) |
| Enumeration Date | 2017-03-26 |
| Last Update Date | 2021-09-29 |