| NPI | 1801355888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX V6989) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME161857) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2025-04-23 |