| NPI | 1215112578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA MD.203713) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 136354) |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2022-08-24 |