| NPI | 1790120202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 326020) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VI 3951) |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2026-04-27 |