| NPI | 1194119164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA OS019879) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA OT016929) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2021-02-11 |