| NPI | 1508833997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101242380) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 225177) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2026-09-18 |