| NPI | 1659357010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL OS12357) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: HI DOS-1052) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2018-10-18 |