| NPI | 1104988955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX U9495) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 21638-020) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2024-05-14 |