| NPI | 1548794316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SD 12801) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NE 33696) |
| 207W00000X Ophthalmology (Licence: MN 64021) | |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2026-02-12 |