| NPI | 1023677812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 339152) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-09970) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2026-04-21 |