| NPI | 1508878364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ND 16550) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NE 23263) |
| 207W00000X Ophthalmology (Licence: MN 67308) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2021-11-23 |