| NPI | 1366717605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 52180) |
| Additional Taxonomies | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: SC 52180) |
| 207W00000X Ophthalmology (Licence: NC 2016-00724) | |
| 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: NC 2016-00724) | |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2021-01-13 |