| NPI | 1336112812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA C149136) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME72613) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2020-06-22 |