| NPI | 1659406072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX H8526) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2013038718) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2025-04-21 |