| NPI | 1962792630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101252608) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101252608) |
| 207WX0110X Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist (Licence: VA 0101252608) | |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2019-07-10 |