| NPI | 1720296742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME112639) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AL 27559) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2025-04-30 |