| NPI | 1801059605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 5934) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 5934) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2012-07-10 |