| NPI | 1154301844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2006-01037) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 37314-020) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2021-03-30 |