| NPI | 1174010201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 073330) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 291579) |
| Enumeration Date | 2018-04-14 |
| Last Update Date | 2025-01-27 |