| NPI | 1770214983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA R-12610) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA R-12610) |
| Enumeration Date | 2022-06-20 |
| Last Update Date | 2022-06-20 |