| NPI | 1821036088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VT 0420007142) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 53383) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2018-03-30 |