| NPI | 1245935535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 3015589) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2023-00742) |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2024-09-29 |