| NPI | 1730613621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 75178-20) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 75178) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2022-08-10 |