| NPI | 1356845614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 77139) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 65841) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2022-08-03 |