| NPI | 1720210628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 311531) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NM MD2014-0648) |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2019-03-22 |