| NPI | 1851464028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101264731) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WV 10170) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2023-08-10 |