| NPI | 1699923516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2023-03120) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NE 24771) |
| 207W00000X Ophthalmology (Licence: GA 79768) | |
| 208D00000X General Practice (Licence: NE 24771) | |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2025-06-26 |