| NPI | 1114506714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD224548) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 12974670-1205) |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2025-07-15 |