| NPI | 1265497556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 50244) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 51736) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2021-06-10 |