| NPI | 1942648902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301117177) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA 44282) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2022-07-18 |