| NPI | 1023088770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA G178560) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WV 29367) |
| 207W00000X Ophthalmology (Licence: SC 14023) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2024-06-25 |