| NPI | 1649225640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME86573) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 238661) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2020-12-08 |