| NPI | 1760477624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 324850) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 227620) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2021-02-17 |