| NPI | 1366838120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 82737) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 82133) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2019-06-19 |