| NPI | 1366735623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AL md.35139) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY R2751) |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2020-07-17 |