| NPI | 1689057135 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX V4090) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 7528) | 
| 207W00000X Ophthalmology (Licence: SC 82443) | |
| 207W00000X Ophthalmology (Licence: SD 12043) | |
| Enumeration Date | 2015-07-01 | 
| Last Update Date | 2025-09-01 |