| NPI | 1518725480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 5001542) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL TRN39007) |
| 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: FL TRN39007) | |
| Enumeration Date | 2024-03-06 |
| Last Update Date | 2025-10-01 |