| NPI | 1164800827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NV 19705) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD467621) |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2020-09-25 |