| NPI | 1164882692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX S6928) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 30179) |
| Enumeration Date | 2016-02-25 |
| Last Update Date | 2021-04-20 |