| NPI | 1568428530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101246434) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 9801734) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2023-03-07 |