| NPI | 1689939795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VT 042.0019023) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 1025581) |
| 207W00000X Ophthalmology (Licence: NH 21250) | |
| 207W00000X Ophthalmology (Licence: VA 0101254699) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2026-02-03 |