| NPI | 1790097681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 82300) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA OT013796) |
| 207W00000X Ophthalmology (Licence: FL OS12787) | |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2020-02-05 |