| NPI | 1851364723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 12404247-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AZ 20810) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2024-07-03 |