| NPI | 1588008031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD.MD.61009280) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 287087) |
| 207W00000X Ophthalmology (Licence: MN 58971) | |
| Enumeration Date | 2013-04-26 |
| Last Update Date | 2026-08-28 |