| NPI | 1730875535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 85855-20) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 100122) |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2025-06-09 |