| NPI | 1710443403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AK 207658) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101271479) |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2025-02-27 |