| NPI | 1407424187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A2029132) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-12259) |
| 207W00000X Ophthalmology (Licence: IA R-12259) | |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2025-07-07 |