| NPI | 1932859949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 13525989-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301516121) |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2026-03-05 |