| NPI | 1285044107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301501258) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 68700-20) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2020-10-01 |