| NPI | 1720247752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL MFC1725) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX FTL 42093) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2020-06-01 |