| NPI | 1124862024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX BP10089884) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10089884) |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2025-07-02 |