| NPI | 1447612478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101268521) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY R4000) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2020-06-29 |