| NPI | 1134119787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 9600511) |
| Additional Taxonomies | 207WX0110X Ophthalmology Pediatric Ophthalmology and Strabismus Specialist (Licence: NC 9600511) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2022-03-31 |