| NPI | 1285678029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 21937) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 047047) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2020-09-19 |