| NPI | 1124517966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 81465) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0116033416) |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2023-08-07 |