| NPI | 1760432801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A84915) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 61218121205) |
| 207W00000X Ophthalmology (Licence: PA MD434362) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: UT 61218121205) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A84915) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2011-09-20 |