| NPI | 1083741961 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207WX0109X Ophthalmology, Neuro-ophthalmology (Licence: KY 28343) | 
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 04-35404) | 
| 207WX0109X Ophthalmology, Neuro-ophthalmology (Licence: AZ 28419) | |
| 207YX0901X Otolaryngology, Otology & Neurotology (Licence: KS 04-35404) | |
| 207YX0901X Otolaryngology, Otology & Neurotology (Licence: KY 28343) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: KS 04-35404) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2019042323) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 28343) | |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: AZ 28419) | |
| Enumeration Date | 2007-02-27 | 
| Last Update Date | 2025-03-10 |