| NPI | 1336117217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GU 1687) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: HI 12540) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2025-09-17 |