| NPI | 1659996833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX W4943) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX W4943) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: CO DR.0072940) | |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2026-06-17 |