| NPI | 1790246585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC MMD.89111) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 250067) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2023-07-06 |