| NPI | 1003170036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MS 24793) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL34829) |
| 207W00000X Ophthalmology (Licence: WV 25993) | |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2026-05-15 |