| NPI | 1912297284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A135673) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.059238) |
| 207W00000X Ophthalmology (Licence: MD p28486) | |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2019-05-01 |