| NPI | 1871849091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A122223) |
| Additional Taxonomies | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: CA 122223) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2017-03-21 |