| NPI | 1477114296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301509019) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4351044807) |
| 207W00000X Ophthalmology (Licence: TX V8695) | |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2025-09-08 |