| NPI | 1013257575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2017029105) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI L2316364) |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2018-02-21 |