| NPI | 1790048155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2016-00381) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 251633) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2016-05-02 |