| NPI | 1750517710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME117902) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 770778) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2021-09-29 |