| NPI | 1639131972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2011-00185) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101236236896) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2018-05-31 |