| NPI | 1144683517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 75083) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101269431) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2021-06-08 |