| NPI | 1730570896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA 20A17131) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL OS14981) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2020-06-22 |