| NPI | 1720460181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 202-03988) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 5101022029) |
| 207W00000X Ophthalmology (Licence: SC DO83356) | |
| 207W00000X Ophthalmology (Licence: MI 5151010319) | |
| 207W00000X Ophthalmology (Licence: TX S0721) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2023-04-27 |