| NPI | 1376922948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AL 41653) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TN 59163) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2025-12-30 |