| NPI | 1780689141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN 17027) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN MD017027) |
| 207P00000X Emergency Medicine (Licence: TN 17027) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2022-03-31 |