| NPI | 1548534381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 83038) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA OS017900) |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2023-08-15 |