| NPI | 1073703757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 005247) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 5101017038) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2019-05-02 |