| NPI | 1841812575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A192823) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA R-11784) |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2025-07-24 |