| NPI | 1093244790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101276312) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301504403) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2022-10-05 |