| NPI | 1780631994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101281795) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D58677) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2026-09-30 |