| NPI | 1154777886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX W3047) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME156135) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2026-06-25 |