| NPI | 1760438238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NV DO1810) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AZ 4434) |
| 207W00000X Ophthalmology (Licence: OH DE4130181) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2021-08-19 |