| NPI | 1073008777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A175144) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 291384) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2025-09-02 |