| NPI | 1053504399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2012-00154) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 33790) |
| 207WX0110X Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist (Licence: NC 2012-00154) | |
| 207WX0110X Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist (Licence: SC 33790) | |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2020-09-29 |