| NPI | 1235517434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A143690) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207W00000X Ophthalmology (Licence: IN 01081408A) | |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2024-08-19 |