| NPI | 1790778520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: UT 184400-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 184400-1205) |
| 207W00000X Ophthalmology (Licence: AZ 19987) | |
| 208D00000X General Practice (Licence: AZ 19987) | |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2021-07-13 |