| NPI | 1659791945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A140173) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 274727) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2019-07-22 |