| NPI | 1205185139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL OS18868) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 12400) |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2023-09-01 |