| NPI | 1659375483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 28666) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 010132083) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2021-09-20 |