| NPI | 1477617892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 74363) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101239940) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2021-04-06 |