| NPI | 1942769831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A200827) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.147835) |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-12-02 |