| NPI | 1063894749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA OS019757) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA OT016521) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2021-03-25 |