| NPI | 1083970628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.142154) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101254759) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2023-10-10 |