| NPI | 1780940155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 70092) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 62103) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2022-07-21 |