| NPI | 1962930941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA DO-05771) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10960) |
| 207W00000X Ophthalmology (Licence: OH 58.030427) | |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2021-06-24 |