| NPI | 1255790085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2019-02855) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA 139286) |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2024-01-16 |