| NPI | 1700376795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MS 32421) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL 156595) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2024-06-11 |