| NPI | 1477524239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA C42711) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME90641) |
| 207W00000X Ophthalmology (Licence: CT 72389) | |
| 207W00000X Ophthalmology (Licence: NE 14789) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2023-07-18 |