| NPI | 1184614190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO 46502) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NM MD2005-0516) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2026-06-24 |