| NPI | 1417744764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 336288) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WV 36221) |
| Enumeration Date | 2025-04-21 |
| Last Update Date | 2026-03-30 |