| NPI | 1750039236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.149136) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD 35.149136) |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2024-01-09 |