| NPI | 1255865788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 33546) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA MD-52809) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2026-02-04 |