| NPI | 1548433600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA C144717) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301100805) |
| 207W00000X Ophthalmology (Licence: WI 52233-20) | |
| 207W00000X Ophthalmology (Licence: MD D0071980) | |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2020-06-22 |