| NPI | 1912602541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL MFC1884) |
| Additional Taxonomies | 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery (Licence: FL 1884) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2023-05-18 |