| NPI | 1114981826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WV 21418) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 200501699) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2021-12-02 |