| NPI | 1649256512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 63552) |
| Additional Taxonomies | 156FX1202X Technician/Technologist, Optometric Technician |
| 207W00000X Ophthalmology (Licence: IN 01058559A) | |
| 207W00000X Ophthalmology (Licence: IL 036107142) | |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2024-03-02 |