| NPI | 1962456905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VT 042-0006501) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 45884) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2018-03-30 |