| NPI | 1275370231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 35677) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2024-01864) |
| Enumeration Date | 2024-07-09 |
| Last Update Date | 2025-08-19 |