| NPI | 1760910483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 63097) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 235992) |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2021-06-07 |