| NPI | 1972133262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301513988) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2022002887) |
| Enumeration Date | 2020-01-25 |
| Last Update Date | 2025-06-12 |