| NPI | 1528647963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A179818) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA PTL6166) |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2025-07-07 |