| NPI | 1700856283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 54204) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NM MD2016-0963) |
| 207W00000X Ophthalmology (Licence: NE 22276) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2021-04-12 |