| NPI | 1154855583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 51112) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0116031349) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2021-08-18 |