| NPI | 1376506873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101233782) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A49545) |
| 207W00000X Ophthalmology (Licence: MD D0059626) | |
| 207W00000X Ophthalmology (Licence: DC MD 34095) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2025-04-11 |