| NPI | 1043218159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 67111) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 46944) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2021-11-03 |