| NPI | 1508245762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2021-01463) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 82087) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2021-12-01 |