| NPI | 1750384715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SD 0840) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NE 17563) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2019-10-01 |