| NPI | 1750762340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A149439) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2023-08-29 |