| NPI | 1790783041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2024004550) |
| Additional Taxonomies | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: MO 2024004550) |
| 207W00000X Ophthalmology (Licence: MT 164310) | |
| 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: WA MD00042059) | |
| 207W00000X Ophthalmology (Licence: WA MD00042059) | |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2026-05-27 |