| NPI | 1538457130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301096056) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2011012578) |
| Enumeration Date | 2011-07-16 |
| Last Update Date | 2021-10-21 |