| NPI | 1225590326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0102206232) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 109343) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2026-01-26 |