| NPI | 1346085461 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX V1085) | 
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX V1085) | 
| Enumeration Date | 2024-06-29 | 
| Last Update Date | 2025-10-07 |