| NPI | 1144255100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 200400451) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101281793) |
| 207W00000X Ophthalmology (Licence: GA 050493) | |
| 207W00000X Ophthalmology (Licence: TN 70159) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2024-04-24 |