| NPI | 1215660832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX W5609) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2022023554) |
| Enumeration Date | 2022-07-01 |
| Last Update Date | 2026-07-15 |