| NPI | 1952621211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2015-01366) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN15187) |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2022-02-04 |