| NPI | 1114160918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 70638) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2012011111) |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2019-08-01 |