| NPI | 1033598404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 64822) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301118999) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2021-04-23 |