| NPI | 1912467580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301509198) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX V2819) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2024-08-08 |