| NPI | 1134182645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301075698) |
| Additional Taxonomies | 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery (Licence: MI 4301075698) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2020-07-07 |