| NPI | 1215558218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.155863) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY R6382) |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2026-05-12 |