| NPI | 1225456015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301117340) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101264049) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2020-02-25 |