| NPI | 1851344667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD18666) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 30047) |
| 207W00000X Ophthalmology (Licence: CA G65424) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2019-04-09 |