| NPI | 1104264514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: HI MD20850) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NE 28486) |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2021-09-20 |