| NPI | 1710245824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A161126) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0116024719) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2023-08-16 |