| NPI | 1992265862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX U2598) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO Pending) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2024-04-29 |