| NPI | 1497040307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301504185) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD171711) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2021-08-04 |