| NPI | 1912893702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2025023211) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2025023211) |
| Enumeration Date | 2025-06-17 |
| Last Update Date | 2025-06-18 |