| NPI | 1942205240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA G84602) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301069854) |
| 207W00000X Ophthalmology (Licence: UT 358057-1205) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2023-03-07 |