| NPI | 1790702652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: WI 36086) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 36086) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2026-05-19 |