| NPI | 1629059860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2010-00023) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 29832) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2025-02-12 |