| NPI | 1568571107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101247600) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DC md038772) |
| 207W00000X Ophthalmology (Licence: MD d0070896) | |
| 207W00000X Ophthalmology (Licence: FL 103962) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2021-07-06 |