| NPI | 1134747819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO DR.0075480) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2024024713) |
| Enumeration Date | 2020-07-09 |
| Last Update Date | 2025-09-10 |