| NPI | 1932190782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301104424) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CO 45762) |
| Enumeration Date | 2005-11-01 |
| Last Update Date | 2025-02-12 |