| NPI | 1164860151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 269694) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NH 20520) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2026-05-08 |