| NPI | 1043674013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO DR.0067387) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101268622) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2022-01-17 |