| NPI | 1558030916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX W4052) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 13845) |
| Enumeration Date | 2021-09-09 |
| Last Update Date | 2026-06-09 |