| NPI | 1841654456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 67002) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10056237) |
| Enumeration Date | 2016-04-09 |
| Last Update Date | 2023-10-13 |