| NPI | 1104829449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MI 040476) |
| Additional Taxonomies | 174400000X Specialist (Licence: WI 28873-20) |
| 207W00000X Ophthalmology (Licence: MI 040476) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2019-01-28 |