| NPI | 1528042298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.122557) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 226356) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2021-01-14 |