| NPI | 1679137574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD484706) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD 7084D96724) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2024-06-05 |