| NPI | 1255851952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301506618) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301112664) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2022-12-15 |