| NPI | 1952664260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 10179215-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301100655) |
| 207W00000X Ophthalmology (Licence: ID M-13380) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2021-02-24 |