| NPI | 1669051835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2025-01202) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.156132) |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2026-05-27 |