| NPI | 1821486796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL MFC1745) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ZZ 64267) |
| Enumeration Date | 2014-12-31 |
| Last Update Date | 2016-01-13 |