| NPI | 1972000164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA MD-52218) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NV 21795) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2024-02-21 |