| NPI | 1639372345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 053760) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NH 14895) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2023-02-22 |