| NPI | 1659532646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 76694) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA L-235764) |
| 207W00000X Ophthalmology (Licence: TN MD50438) | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2024-07-08 |