| NPI | 1376507111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 083977) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX L3731) |
| 207W00000X Ophthalmology (Licence: PA MD426415) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2026-08-03 |