| NPI | 1750503819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2014-01313) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 001774) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-10-26 |