| NPI | 1053758136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 29341) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2017-01435) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2020-08-08 |