| NPI | 1356793004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ND 14730) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA 308608) |
| 208D00000X General Practice (Licence: ND PT14730) | |
| 207W00000X Ophthalmology (Licence: MO 2021027439) | |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2023-12-22 |