| NPI | 1356345615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2021-01672) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101047807) |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2022-07-13 |