| NPI | 1639166069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 26641) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TN 39584) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2020-05-15 |