| NPI | 1871521625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 25469) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 21880) |
| 207W00000X Ophthalmology (Licence: TN 35450) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2023-03-07 |