| NPI | 1114985207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA OT009913) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA 20A9481) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2020-08-10 |