| NPI | 1568774628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME143292) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 04-38026) |
| 207W00000X Ophthalmology (Licence: MO 2015014708) | |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2020-09-25 |