| NPI | 1558710970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 54113) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TN 69303) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2025-10-21 |