| NPI | 1912960212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 13786) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2009-00114) |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2018-03-28 |