| NPI | 1679991467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 330400) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TN 60167) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2024-07-23 |