| NPI | 1659997724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD.61592102) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2020018154) |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2024-11-15 |