| NPI | 1790717601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 015650) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 015650) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2019-05-03 |