| NPI | 1104036128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA 103802) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AZ 67433) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2025-12-19 |