| NPI | 1770972440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD210044) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 11651272-1205) |
| Enumeration Date | 2015-01-17 |
| Last Update Date | 2022-06-20 |