| NPI | 1154993905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101278231) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL 32221) |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2023-08-16 |