| NPI | 1508158544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC TL38008) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 173270) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2026-04-30 |