| NPI | 1003064577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ID M-11960) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR LL17804) |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2024-04-12 |