| NPI | 1295154938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX W0552) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: TX W0552) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2025-08-19 |