| NPI | 1265968614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ME DO3184) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CO TL.0007523) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2021-07-27 |