| NPI | 1154382612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 9800130) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101044852) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2021-10-11 |