| NPI | 1396900379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 5101016997) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA D0.000211) |
| 207W00000X Ophthalmology (Licence: PA OT012221) | |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2023-11-22 |