| NPI | 1629090683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 34169) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CT 025474) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2019-05-14 |