| NPI | 1710470281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 338669) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI EMC0009269) |
| Enumeration Date | 2018-06-10 |
| Last Update Date | 2026-04-28 |