| NPI | 1598320798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 77348) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 13258986-1205) |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2026-06-08 |