| NPI | 1184616989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101014540) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MS 23440) |
| 207W00000X Ophthalmology (Licence: TN 51748) | |
| 207W00000X Ophthalmology (Licence: FL 116425) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2023-03-07 |