| NPI | 1902148679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101261878) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301102648) |
| 207W00000X Ophthalmology (Licence: MI 4301102648) | |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2022-07-21 |