| NPI | 1376827642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101253385) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA 1) |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2021-07-01 |