| NPI | 1699351635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD488897) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 31532) |
| Enumeration Date | 2021-03-21 |
| Last Update Date | 2025-06-23 |