| NPI | 1902853393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN MD015570) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AR N-8358) |
| 207W00000X Ophthalmology (Licence: AL MD9957) | |
| 207W00000X Ophthalmology (Licence: MS 19211) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2018-01-15 |