| NPI | 1720073224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 200100584) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA MD.12052R) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2019-02-13 |