| NPI | 1043646672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL OS15204) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA Ot015917) |
| Enumeration Date | 2013-09-14 |
| Last Update Date | 2024-09-09 |