| NPI | 1457700445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35141688) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 283027) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2021-06-07 |