| NPI | 1205122173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0102204508) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 5101019254) |
| 207W00000X Ophthalmology (Licence: NC 2015-00459) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2017-10-14 |