| NPI | 1871119461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2022024172) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2020017595) |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2022-08-15 |