| NPI | 1578689568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NH 20491) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VT 0420009901) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2020-06-04 |