| NPI | 1750802880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A178045) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301113382) |
| 207W00000X Ophthalmology (Licence: GA 88200) | |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2022-08-19 |