| NPI | 1700273539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101273193) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0116029599) |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2021-09-10 |