| NPI | 1336196260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX U1173) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 69416) |
| 207WX0109X Ophthalmology, Neuro-ophthalmology (Licence: MS 11496) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2023-11-06 |