| NPI | 1659431054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301054513) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 054513) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2022-04-21 |