| NPI | 1558421958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 68962) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301052730) |
| 207W00000X Ophthalmology (Licence: MN 50022) | |
| 207W00000X Ophthalmology (Licence: NY 273321) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2018-07-10 |