| NPI | 1487874582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2009023915) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 72634) |
| Enumeration Date | 2007-04-30 |
| Last Update Date | 2022-09-23 |