| NPI | 1215904974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA C206920) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OK 17656) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2026-01-22 |