| NPI | 1073180642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2025-00988) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 12976) |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2025-07-28 |