| NPI | 1235556143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301116920) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 9529228-1205) |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2020-02-05 |