| NPI | 1255863239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 77041) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 287441) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2022-08-23 |