| NPI | 1073855243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 30789) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2017007168) |
| 207W00000X Ophthalmology (Licence: IA 45207) | |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2021-09-17 |