| NPI | 1295058790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 201802495) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301095784) |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2019-08-21 |