| NPI | 1740288455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX T4173) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX T4173) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2026-01-09 |