| NPI | 1083021554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 04355) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0102205806) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2024-05-23 |