| NPI | 1285632356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO R1H47) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 04-24084) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2019-07-08 |