| NPI | 1700104346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 56408) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2015017959) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2020-03-28 |