| NPI | 1881156149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101277548) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 11923) |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2025-05-01 |