| NPI | 1295845154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101260900) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 36311) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-08-08 |