| NPI | 1205511631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0110X Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist (Licence: MO 2025029735) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2025029735) |
| 207W00000X Ophthalmology (Licence: OH 113979) | |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2025-07-21 |