| NPI | 1003443680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101278847) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0116033646) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2024-01-10 |