| NPI | 1932519410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA OS019294) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA OT015751) |
| 207W00000X Ophthalmology (Licence: MI 5101021782) | |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2019-10-11 |