| NPI | 1528766995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC LL94802) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL94802) |
| Enumeration Date | 2023-02-15 |
| Last Update Date | 2025-06-29 |