| NPI | 1821068107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX W3437) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DE C1-0008619) |
| 207W00000X Ophthalmology (Licence: MD D0067113) | |
| 207W00000X Ophthalmology (Licence: PA MD454657) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2026-06-16 |