| NPI | 1811212178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 63687) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 258561) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2019-10-03 |