| NPI | 1235591355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 54412) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY R4194) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2022-04-14 |