| NPI | 1164797270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2016010391) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 10392993-1205) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2025-10-09 |