| NPI | 1801060454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 38382) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2012-00308) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2022-03-10 |