| NPI | 1750964649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD488494) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101289275) |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2026-05-21 |