| NPI | 1194256479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 13000441-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NV 23619) |
| 207W00000X Ophthalmology (Licence: WY 15234A) | |
| 207W00000X Ophthalmology (Licence: MT MED-PHYS-LIC-115061) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2026-01-23 |