| NPI | 1659622900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 56209) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WV 2861) |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2022-07-21 |