| NPI | 1497784300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A83613) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA 36642) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2020-03-02 |