| NPI | 1609805522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 081784) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OK 26270) |
| 207W00000X Ophthalmology (Licence: IA 36592) | |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2019-09-11 |