| NPI | 1689644817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A94551) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301085099) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2023-03-07 |