| NPI | 1174028096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.150595) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 291517) |
| Enumeration Date | 2018-03-25 |
| Last Update Date | 2024-07-15 |