| NPI | 1043638661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301105488) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NV 18825) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2024-03-28 |