| NPI | 1356394712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 50043) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 26502-020) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2021-11-11 |