| NPI | 1619137320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME109536) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: FL ME109536) |
| 207W00000X Ophthalmology (Licence: TX N2461) | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2025-12-22 |