| NPI | 1811239320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN MD55336) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA 325882) |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2022-07-07 |