| NPI | 1518595958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD229341) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 83222-20) |
| 207W00000X Ophthalmology (Licence: UT 12403679-1205) | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2026-07-02 |