| NPI | 1093165490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301503702) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2020016137) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2021-07-06 |