| NPI | 1437163664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME90525) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX M2915) |
| 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: TX m2915) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2025-01-27 |