| NPI | 1720077993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO DR.0057386) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2009032081) |
| 207W00000X Ophthalmology (Licence: VA 0101237885) | |
| 207W00000X Ophthalmology (Licence: GA 74395) | |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2021-06-21 |