| NPI | 1255692414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 29974) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 31952) |
| 207W00000X Ophthalmology (Licence: VA 0101041515) | |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2018-03-17 |