| NPI | 1518212893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ND 15921) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR DO176816) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2019-08-16 |