| NPI | 1154311058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA G66270) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME56477) |
| 207W00000X Ophthalmology (Licence: NV 14270) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2023-08-17 |