| NPI | 1093822561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 6540468-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO T2003013455) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2026-02-25 |