| NPI | 1053818534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2023-00872) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2022027091) |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2024-01-22 |